Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 839
  • Home
  • Print this page
  • Email this page

   Table of Contents      
BRIEF COMMUNICATION
Year : 2014  |  Volume : 62  |  Issue : 7  |  Page : 812-813

Luxation of Eye ball following trauma: Novel simple treatment


Department of Ophthalmology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission20-May-2013
Date of Acceptance17-Jun-2014
Date of Web Publication13-Aug-2014

Correspondence Address:
Essam A Osman
Department of Ophthalmology, Faculty of Medicine, King Saud University, King Abdul-Aziz Road, P.O. Box 245, Riyadh 11411
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.138626

Rights and Permissions
  Abstract 

Luxation of the eye globe is a rare occasion but it carries a risk of threat to permanent vision loss especially when associated with very high intraocular pressure. Appropriate intervention should be undertaken instantly. Predisposing factors include; eyes as in shallow orbital sockets, floppy eyelid syndrome, and exophthalmos. Prompt reduction results in restoration of full anatomical and visual recovery in otherwise healthy eyes. We report a case of globe luxation following trauma by door handle in a 65-year-old female, who recovered completely after reposition of the globe using Desmarres Lid Retractors.

Keywords: Blunt trauma, Desmarres lid retractors, globe luxation


How to cite this article:
Osman EA, Al-Akeely A. Luxation of Eye ball following trauma: Novel simple treatment. Indian J Ophthalmol 2014;62:812-3

How to cite this URL:
Osman EA, Al-Akeely A. Luxation of Eye ball following trauma: Novel simple treatment. Indian J Ophthalmol [serial online] 2014 [cited 2020 Apr 8];62:812-3. Available from: http://www.ijo.in/text.asp?2014/62/7/812/138626

Luxation of the eye globe is a rare condition but it carries a risk of permanent visual loss. Globe luxation has generally been categorized as spontaneous, voluntary or traumatic. Luxation occurs when the equator of the globe is allowed to protrude anterior to the eyelid aperture. The orbicularis muscle contracts, voluntarily or involuntarily, causing further anterior displacement and the globe is caught outside the eyelid aperture. Spontaneous luxation occurs without conscious effort, with or without a precipitating factor. [1] Voluntary luxation is the ability to luxate one's globe at will, without any precipitating trigger. Traumatic luxation occurs without conscious effort after trauma as a result of a dynamic interplay of forces, [2] Pro-pulsing the globe forward after entering an elongated object to the medial orbit. [3] Immediate reduction is warranted if the globe is still intact to minimize the ischemia to ocular structures. [4] We report a patient who developed traumatic globe luxation caused by a door handle, which rarely occurs in adults, that was treated simply by using Desmarres Lid Retractors under topical anesthesia.


  Case Report Top


A 65-year-old woman presented to the emergency department with severe ocular pain in the right eye; the patient gave a history of trauma sustained from a door handle three hours back. On examination, her visual acuity in the right eye was hand motion (HM), upper and lower lids behind the luxated globe, IOP 54 mmHg, corneal edema, deep quite anterior chamber and hazy view to the retina [Figure 1]. Left eye examination was unremarkable. The case was diagnosed as retro bulbar hemorrhage by the emergency resident on call, in which urgent brain and orbit computed tomography (CT) scan revealed only globe luxation with retracted swollen eyelids and no evidence of intracranial or intraorbital hemorrhages or orbital wall fractures [Figure 2], while B scan revealed no evidence of optic nerve avulsion.
Figure 1: Right eye with visual acuity of HM

Click here to view
Figure 2: Intraorbital hemorrhages or orbital wall fractures

Click here to view


Topical benoxiate drops were administered to the right eye and a trial to reposition the globe with the help of a cotton tip applicator was unsuccessful. Desmarres Lid Retractors was used in which we inserted the curved tip of the retractor between the upper lid and the globe and by pulling the retractor up and superior the globe retracted back to its place [Figure 3]. The patient felt immediately relieve of pain and reduction of IOP to 21 mmHg without anti-glaucoma medications and associated with improvement of corneal clarity [Figure 4]. Vision improved up to 20/80 and her Fundus examination did not show any abnormality.
Figure 3: Desmarres Lid Retractors applied to upper lid

Click here to view
Figure 4: Patient eye after treatment

Click here to view


During follow up ptosis was observed in the right eye for the first three weeks, however, this improved gradually and got resolved 6 weeks after the trauma. In the last visit, after 6 months of trauma, the patient presented with visual acuity of 20/60 and IOP of 16 mmHg.


  Discussion Top


Complications associated with spontaneous globe luxation may include exposure keratitis, corneal abrasion, blurred vision, pain, blepharospasm, and anxiety.

Door handles ocular injuries rarely occurs in adults but has been reported to cause significant ocular and periocular injuries among young children. [5] Incidence of optic nerve avulsion is also increased in these patients. [6] Brain and orbital CT scans are required to exclude intracranial bleeding, optic chiasmal injury and bone fractures. [7]

The luxated globe should be managed as an emergency because most cases end with no light perception vision. [8]

A procedure has been described to reduce a luxated globe by patient relaxation and reclining to allow the orbiculais oculi muscle to relax and make globe manipulation easier then rolling back the lids out around the front part of the globe using a finger of cotton swab while gently pushing the globe back into place. [9] In our case we tried a similar approach unsuccessfully and therefore introduced a Desmarres lid retractor as a good option to reposit the globe.

Three cases of unilateral neurogenic blepharoptosis secondary to trauma with complete recovery within the first 3 months which simulates part of our patient presentation has been reported. [10] Our patient ended with good vision and recovered from traumatic ptosis.


  Conclusion Top


Although globe luxation is a devastating consequence to a blunt trauma to the globe, in some instances patients can end up with a favorable outcome with good vision. In our patient early intervention with globe repositioning led to prevention of a well known complication of optic disc damage and can be a key factor to regain good vision. This can be achieved by different maneuvers depending on the location settings and patient cooperation.

 
  References Top

1.
Kunesh JC, Katz SE. Spontaneous globe luxation associated with contact lens placement. CLAO J 2002;28:2-4.  Back to cited text no. 1
    
2.
Bajaj MS, Kedar S, Sethi A, Gupta V. Traumatic globe luxation with optic nerve transection. Orbit 2000;19:165-70.  Back to cited text no. 2
    
3.
Razmjua H, Masjedi M. Traumatic bilateral globe avulsion (case report). J Res Med Sci 2009;14:259-60.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Chhabra HN, Kawuma AM. Luxation of the eyeball. Br J Ophthalmol 1986;70:150-1.  Back to cited text no. 4
[PUBMED]    
5.
Chaudhry IA, Al-Sharif AM, Shamsi FA, Elzaridi E, Al-Rashed W. Severe ocular injuries from pointed door handles in children. Ophthalmology 2005;112:1834-7.  Back to cited text no. 5
    
6.
Chaudhry IA, Shamsi FA, Al-Sharif A, Elzaridi E, Al-Rashed W. Optic nerve avulsion from door-handle trauma in children. Br J Ophthalmol 2006;90:844-6.  Back to cited text no. 6
    
7.
Shneck M, Oshry T, Marcus M, Lifshitz T. Attempted bilateral manual enucleation (gouging) during a physical assault. Ophthalmology 2003;110:575-7.  Back to cited text no. 7
    
8.
Kiratli H, Tumer B, Bilgic S. Management of traumatic luxation of the globe. A case report. Acta Ophthalmol Scand 1999;77:340-2.  Back to cited text no. 8
    
9.
Thapa R. Luxation of eye ball following trauma--a rare case presentation. JNMA J Nepal Med Assoc 2011;51:79-82.  Back to cited text no. 9
[PUBMED]    
10.
McCulley TJ, Kersten RC, Yip CC, Kulwin DR. Isolated unilateral neurogenic blepharoptosis secondary to eyelid trauma. Am J Ophthalmol 2002;134:626-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed1147    
    Printed20    
    Emailed2    
    PDF Downloaded137    
    Comments [Add]    

Recommend this journal